Extracorporeal Membrane Oxygenation for Severe Acute Respiratory Distress Syndrome associated with COVID-19: An Emulated Target Trial Analysis.

RATIONALE: Whether COVID patients may benefit from extracorporeal membrane oxygenation (ECMO) compared with conventional invasive mechanical ventilation (IMV) remains unknown. OBJECTIVES: To estimate the effect of ECMO on 90-Day mortality vs IMV only Methods: Among 4,244 critically ill adult patients with COVID-19 included in a multicenter cohort study, we emulated a target trial comparing the treatment strategies of initiating ECMO vs. no ECMO within 7 days of IMV in patients with severe acute respiratory distress syndrome (PaO2/FiO2 <80 or PaCO2 ≥60 mmHg). We controlled for confounding using a multivariable Cox model based on predefined variables. MAIN RESULTS: 1,235 patients met the full eligibility criteria for the emulated trial, among whom 164 patients initiated ECMO. The ECMO strategy had a higher survival probability at Day-7 from the onset of eligibility criteria (87% vs 83%, risk difference: 4%, 95% CI 0;9%) which decreased during follow-up (survival at Day-90: 63% vs 65%, risk difference: -2%, 95% CI -10;5%). However, ECMO was associated with higher survival when performed in high-volume ECMO centers or in regions where a specific ECMO network organization was set up to handle high demand, and when initiated within the first 4 days of MV and in profoundly hypoxemic patients. CONCLUSIONS: In an emulated trial based on a nationwide COVID-19 cohort, we found differential survival over time of an ECMO compared with a no-ECMO strategy. However, ECMO was consistently associated with better outcomes when performed in high-volume centers and in regions with ECMO capacities specifically organized to handle high demand. This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License 4.0 (http://creativecommons.org/licenses/by-nc-nd/4.0/)

Empirical exploration of the importation, deprivation and integrated models concerning types of aggression in youth custody

Recently in Canada and the United States there has been an intensifying political debate about serious and violent young offenders. The policy issues in the US have focused on capital punishment and mistreatment of incarcerated young offenders, and the implementation of mandatory minimum custodial sentences for young offenders in Canada. There have been few studies on how young offenders adapt to custody. The three dominant perspectives have been the importation, deprivation, and integrated models. Certain key imported, deprivation, and combined factors were statistically related to separate measures of physical, verbal, and property aggression in a sample from British Columbia’s largest young offender’s custodial facility. Qualitative interviews with key government officials provided an historical perspective about the deprivation structure of custody in this facility. Structured in-depth interviews with 189 incarcerated young offenders provided for bi-variate and multi-variate analyses of the relationship between key imported and deprivation variables, and three types of aggression. While imported variables predominated the statistical models, particularly regarding physical aggression, deprivation variables and interactive effects were also identified for verbal and property aggression. This suggested that an integrated model best explained different forms of aggression in youth custody

La consommation de médicaments psycho-actifs chez les jeunes dee 11 à 18 ans

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Risk behaviour, self-esteem and social background of schoolchildren in Belgium: results from a survey and implications for health promotion

info:eu-repo/semantics/publishe

Socio-economic status and health behaviour in Belgium: Results from a survey among schoolchildren (HBSC/WHO study)

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Diffusion through Nanopores in Connected Lipid Bilayer Networks

International audienc

Quasistatic Microdroplet Production in a Capillary Trap

International audienc

Determinants of alcohol consumption in Belgian adolescents

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Illegal drugs use by school children in Belgium: North-South differences

The study > regularly provides comparative data on health behaviour and related lifestyle of pupils from 11 to 18 years old. This study is based on repeated surveys among randomised representative samples of pupils, following the international standardised protocol from the WHO cross-national survey >. In Belgium, results from the 1990 survey (sample=3528) show differences in illegal drugs use between the South (French-speaking) and the North (Flemish-speaking). For example, among the 17 year olds, 9.8 % of the French-speaking pupils and 5.5 % of the Flemish-speaking have already tried illegal drug(s) and in the same age groups, 2.9 % and 1.5 %, respectively declare to be regular users. The first hypotheses concerning those differences take into account the socio-economic and cultural environment as well as methodological problems inherent to these surveys